Comparison of training effects between underwater treadmill gait training and overground gait training on the walking ability and respiratory function in patients with chronic severe hemiplegic stroke: A randomized, controlled, preliminary trial.

BACKGROUND: The need to develop a more effective intervention to obtain a functional recovery of stroke patients who are unable to perform land-based treadmill gait training has been widely reported. Thus, this pilot study aimed to identify a gait training type that could lead to improved gait and respiratory functioning in adult patients with chronic severe hemiplegic stroke. OBJECTIVES: To examine whether underwater treadmill or/and overground gait training could be more effective in stroke patients. METHODS: In this single-blinded, randomized, controlled, comparative study, 22 patients with severe hemiplegic stroke in a rehabilitation hospital were randomly assigned to the experimental (underwater treadmill gait training) or control group (overground gait training). All participants performed a 60-min neurodevelopmental treatment (five times/week for 12 weeks). Each group performed 30-min underwater or overground gait training (two times/week for 12 weeks). Gait and respiratory function were measured before and after the 12-week training. RESULTS: For the walking variables, step-time difference changes post-training showed significant differences between the groups (-.06 vs. +.04 s, p < .05). Both groups showed significant increases in the maximal voluntary volume (MVV) at post compared to pre training (p < .05). The post-training MVV values were significantly different between the two groups (+23.35 vs. +4.76 L, p < .05). CONCLUSIONS: In severe stroke patients, underwater treadmill gait training can be more effective in improving gait and respiratory function than overground gait training and could be an effective clinical intervention tool for the training of such patients.

Muscle activities of lower extremity and erector spinae muscles according to ankle joint position during squat exercise.

OBJECTIVE: The purpose of this study was to investigate the most effective ankle joint position for squat exercise by comparing muscle activities of lower extremity and erector spinae muscles in different ankle joint positions. METHODS: Thirty-seven normal healthy adults in their 20s participated in this study. Muscle activities of dominant vastus medialis oblique, vastus lateralis, biceps femoris, and erect spinae were measured in three ankle joint positions; dorsiflexion, neutral, and plantar flexion. RESULTS: Muscle activities of the vastus medialis oblique, vastus lateralis, and erector spinae muscles were statistically different in the three ankle joint positions during squat exercise (p< 0.05). Vastus medialis oblique muscles showed higher muscle activity in ankle plantar flexion than in the dorsiflexion or neutral positions (plantar flexion > neutral position, +3.3% of maximal voluntary isometric contraction (MVIC); plantar flexion > dorsiflexion, +12.2% of MVIC, respectively). Vastus lateralis muscles showed 7.1% of MVIC greater muscle activity in the neutral position than in dorsiflexion, and erector spinae muscles showed higher muscle activity in dorsiflexion than in plantar flexion or in the neutral position (dorsiflexion > neutral position, +4.3% of MVIC; dorsiflexion > plantar flexion, +7.1% of MVIC, respectively). CONCLUSION: In squat exercises designed to strengthen the vastus medialis oblique, ankle joint plantar flexion is probably the most effective ankle training position, and the dorsiflexion position might be the most effective exercise for strengthening the erector spinae muscle.

Cross training effects of non-paralytic dorsiflexion muscle strengthening exercise on paralytic dorsiflexor muscle activity, gait ability, and balancing ability in patients with chronic stroke: A randomized, controlled, pilot trial.

OBJECTIVE: To investigate the effects of non-paralytic dorsiflexion muscle strengthening exercise on functional abilities in chronic hemiplegic patients after stroke. METHODS: A total of 21 patients with chronic stroke underwent dorsiflexion muscle strengthening exercise (MST) 5 times a week for 6 weeks (the experimental group, MST to non-paralytic dorsiflexion muscles, n=11; the control group, MST to paralytic dorsiflexion muscles; n=10). Paralytic dorsiflexor muscle activities (DFA) and 10 m walking tests (10MWT) and timed up and go tests (TUG) were measured before and after intervention. RESULTS: A significant increase in DFA was observed after intervention in the experimental and control groups (p<0.05) (experimental 886.6% for reference voluntary contraction (RVC), control 931.6% for RVC). TUG and 10MWT results showed significant reductions post-intervention in the experimental and control groups (experimental group -5.6 sec, control -4.8 sec; experimental group -3.1 sec, control, -3.9 sec; respectively). No significant intergroup difference was observed between changes in DFA or between changes in TUG and 10MWT results after intervention (p>.05). CONCLUSION: Strengthening exercise performed on non-paralytic dorsiflexion muscles had positive cross-training effects on paralytic dorsiflexor muscle activities, balance abilities, and walking abilities in patients with chronic stroke.

Efficacy and safety of thread embedding acupuncture for chronic low back pain: a randomized controlled pilot trial.

BACKGROUND: We investigated the efficacy and safety of thread-embedding acupuncture (TEA) for chronic low back pain (LBP) in a randomized controlled pilot trial with the aim of laying the foundation for a large-scale randomized controlled trial on this topic. METHODS: Forty participants were recruited for this two-arm, assessor-blinded randomized controlled pilot trial. The participants were randomly allocated to a TEA group (experimental group) or an acupuncture group (control group). The TEA group received TEA once every 2 weeks for 8 weeks (four sessions in total), while the acupuncture group received acupuncture twice per week for 8 weeks (16 sessions in total). The primary outcome was the visual analog scale (VAS) score for pain and the secondary outcomes were short-form McGill Pain Questionnaire (SF-MPQ) and Oswestry Disability Index (ODI) scores. Assessments were performed at screening and at 2, 4, 6, 8, and 10 weeks after treatment initiation (the 10-week assessment was conducted at 2 weeks after treatment cessation). RESULTS: Of the 40 participants, 36 completed the study and four dropped out. Both the TEA group and the acupuncture group showed significant improvements in VAS, SF-MPQ, and ODI scores in a time-dependent manner. Furthermore, with regard to ODI, a significant interaction between group and time was observed, with the two groups exhibiting a different pattern of change at 8 weeks according to contrast analysis with Bonferroni's correction. No serious adverse event occurred, and hematological and biochemical test findings were within normal limits. CONCLUSION: This pilot study has provided basic data for a larger clinical trial to demonstrate the efficacy and safety of TEA for chronic LBP. TRIAL REGISTRATION: Clinical Research Information Service of the Korea National Institute of Health, ID: KCT0001819 . Registered on 15 February 2016.

Evolutionary relationships of the hexon and penton base genes of novel squirrel adenovirus.

Squirrel adenovirus (SqAdV) was reported previously. However, only partial sequences of its hexon and polymerase genes have been revealed. For the first time, we report the full-length genome of SqAdV including the complete hexon and penton base genes. From internal body organs of 59 red squirrels archived in Korea Bank for Pathogenic Viruses, the hexon, penton base, and full-length genome of SqAdV were determined by a PCR method. Of the internal body organs examined, the spleen showed the highest detection rate (25.42%) for SqAdV whereas the kidney and lung exhibited 18.64% and 3.39% rates, respectively. Based on the phylogenetic relationships of the hexon and penton base genes, SqAdV appears to belong to the genus Mastadenovirus, and, at least in our study, the hexon of SqAdV exhibits the closest relationship to that of an alpaca AdV. Compared with the hexon, the penton base of SqAdV appears to be genetically more divergent from that of other mastadenoviruses. It was also revealed that the full-length SqAdV genome retained AT nucleotide content similar level to AT-rich atadenoviruses, which is unusual for mastadenoviruses. Our results emphasize that SqAdV is classified into the genus Mastadenovirus and demonstrate the AT-biased nucleotide constitution of SqAdV.

Charge and magnetic states of rutile TiO2 doped with Cr ions.

We observe that the electronic and magnetic properties of Cr-doped rutile TiO2 single crystals are highly dependent on growth conditions. The ferromagnetic component of magnetic susceptibility is observed to be enhanced for samples grown under oxygen-rich conditions. To understand the charge state of Cr dopants and their role in response to an external magnetic field, we carry out density functional theory calculations for Cr-doped rutile TiO2. Using the results of formation energy calculations in the presence of oxygen vacancies and Cr atom substitution at the Ti sites, we demonstrate that the Cr3+ state is a source of Curie-Weiss-type magnetic response, whereas the Cr4+ defect states contribute to the ferromagnetic component. We also provide the electronic structures of various defect configurations and attempt to explain the optical and electronic properties of the Cr-doped system.

Experimental evidence for interfacial biochemical bonding in osseointegrated titanium implants.

OBJECTIVES: (i) To identify and quantify an interfacial biochemical bond and the bonding strength of osseointegrated implants with bioactive titanium oxide chemistry, ATiO(x)B (A, metal cations; TiO(x) , titanium oxides/hydroxides; B, non-metal anions) and (ii) to provide quantitative evidence for the biochemical bond theory of osseointegration proposed by Sul et al. for description and explanation of why and how the implants with ATiO(x) B surface oxide chemistry may exhibit a significantly stronger bone response, in spite of the fact that the roughness values approached zero, or were equivalent to or significantly lower than those of the control implants. MATERIALS AND METHODS: We applied a newly developed biochemical bond measurement (BBM) method to model implant surfaces that were "perfectly" smooth nanotopography near-zero roughness as the constant parameter, and used the bioactive surface chemistry of titanium oxide, ATiOx B chemistry as a variable parameter in rabbit tibiae for 10 weeks. In this manner, we determined an interfacial biochemical bond and quantified its bonding strength. RESULTS: The increase in biochemical bond strengths of the test implant relative to the control implant was determined to be 0.018 (±0.008) MPa (0.031 vs 0.021 MPa, n = 10) for tensile strength and 8.9 (±6.1) Ncm (33.0 vs 24.1 Ncm, n = 10) for removal torque. Tensile and removal torque show strong correlation in the Pearson test (r = 0.901, P ≤ 0.001). In addition, histomorphometric measurements including bone-to-metal-contact (BMC, P = 0.007), bone area and newly formed bone showed significant increases in the mean values for ATiO(x) B chemistry (P = 0.007, n = 10). Biochemical bond theory states that the surface oxide chemistry, ATiO(x) B must have more electrical and chemical molecular polarity that fractionally charges the surfaces denoted as δ(+) and δ(-) and leads to electrostatic and electrodynamic interactions with the bone healing cascade, eventually leading to the formation of biochemical bonding at the bone/implant interface. CONCLUSIONS: The present study has provided quantitative evidence for biochemical bond theory of osseointegration of implants with bioactive surface oxide chemistry, ATiO(x) B. The theory of biochemical bonds may provide a scientific rationale pertinent to recent emerging trends and technologies for surface chemistry modifications of implants.

Enzyme replacement therapy improves joint motion and outcome of the 12-min walk test in a mucopolysaccharidosis type VI patient previously treated with bone marrow transplantation.

Mucopolysaccharidosis type VI (MPS VI; Maroteaux-Lamy syndrome, OMIM #253200) is a rare disorder involving multiple organs and manifested particularly by severe skeletal abnormalities. Bone marrow transplantation (BMT) improves cardiopulmonary function and facial features, but has limited success in ameliorating skeletal abnormalities and short stature. Here, we report the outcome of enzyme replacement therapy (ERT) with recombinant human arylsulfatase-B (ASB, Naglazyme, BioMarin, Novato, CA) in an MPS VI patient who received BMT 10 years prior to ERT induction. Administration of weekly Naglazyme for 18 months was effective in improving range of motion in several joints [shoulders (improvement of flexion (Right/Left): 40°/55°; improvement of extension 30°/40°; improvement of abduction 10°/10°), elbows (improvement of flexion 25°/25°; improvement of extension 10°/15°), hips (improvement of flexion 25°/10°), and knees (improvement of flexion 45°/40°; improvement of extension 50°/60°)]. Improvement in the outcome of the 12-min walk test (70% increase) and 3-min stair-climbing test (29% increase) was also noted after ERT. Because ERT improved clinical features in an MPS VI patient who had undergone prior BMT, the role of ERT post successful BMT in MPS VI needs further investigation.

The effect of calcium ion concentration on the bone response to oxidized titanium implants.

AIM: To investigate the effect of calcium concentration on the bone tissue response to Ca-incorporated titanium implants. MATERIALS AND METHODS: Two titanium surfaces containing 4.2% and 6.6% calcium were prepared using the micro-arc oxidation process. The implants were inserted in the tibia of nine New Zealand White rabbits. After 6 weeks of healing, the bone response to the implants was quantitatively compared by biomechanical and histomorphometrical measurements. RESULTS: Ca 4.2% and Ca 6.6% containing implants revealed no distinctive differences in their qualitative surface chemistry; chemical bonding state of Ca in titanium oxide was mainly calcium titanates. No significant differences were observed between two implants in peak removal torque and shear strength comparisons (P>0.05). Histomorphometrical analyses presented no significant differences in bone-metal contact, bone area and newly formed bone measurements between two implants (P>0.05). CONCLUSIONS: From biomechanical and histomorphometrical measurements, the two calcium concentrations in this study did not differ significantly with respect to their influence on the bone tissue response. This similar bone response in rabbit tibiae may be explained by the similarity of the qualitative Ca chemistry in titanium surfaces.

Metal plasma immersion ion implantation and deposition (MePIIID) on screw-shaped titanium implant: The effects of ion source, ion dose and acceleration voltage on surface chemistry and morphology.

The present study investigated the effect of metal plasma immersion ion implantation and deposition (MePIIID) process parameters, i.e., plasma sources of magnesium and calcium, ion dose, and acceleration voltage on the surface chemistry and morphology of screw-type titanium implants that have been most widely used for osseointegrated implants. It is found that irrespective of plasma ion source, surface topography and roughness showed no differences at the nanometer level; that atom concentrations increased with ion dose but decreased with acceleration voltage. Data obtained from X-ray photoelectron spectroscopy and auger electron spectroscopy suggested that MePIIID process produces 'intermixed' layer of cathodic arc deposition and plasma immersion ion implantation. The MePIIID process may create desired bioactive surface chemistry of dental and orthopaedic implants by tailoring ion and plasma sources and thus enable investigations of the effect of the surface chemistry on bone response.

Comparative study on surgical outcomes and operative costs of transumbilical single-port laparoscopic appendectomy versus conventional laparoscopic appendectomy in adult patients.

PURPOSE: To reduce the incisional morbidity and improve cosmesis, the authors adopted a single-port laparoscopic appendectomy using a unique "single-port". The authors retrospectively evaluated transumbilical single-port laparoscopic appendectomy (TUSPLA) against conventional laparoscopic appendectomy (CLA) with respect to perioperative outcomes and operative cost in the adult patients. MATERIALS AND METHODS: The authors reviewed the case of laparoscopic appendectomy between April 2008 and January 2009. Demographic data, operating time, pathology of appendix, hospital stay, surgical morbidities, visual analogue scale pain scores, analgesics requirements, and the operative cost were compared. RESULTS: Seventy-two underwent TUSPLA and 108 underwent CLA. There were more females in the TUSPLA group. Surgical outcomes were similar between the TUSPLA and the CLA group. Operative cost was significantly lower in the TUSPLA group compared with the CLA group. CONCLUSIONS: This study showed that TUSPLA was cost saving and produced similar surgical outcomes in selected appendicitis patients compared with CLA.

XPS, AES and SEM analysis of recent dental implants.

Today, surface chemistry modifications of titanium implants have become a development strategy for dental implants. The present study investigated the chemistry and morphology of commercially available dental implants (Nobel biocare TiUnite, Astra AB OsseoSpeed, 3i Osseotite, ITI-SLA). X-ray photoelectron spectroscopy (XPS) and auger electron spectroscopy were employed for the analysis of surface chemistry. The morphology was investigated by scanning electron microscopy. The present study demonstrated the major differences of surface properties, mainly dependent on the surface treatment used. The blasting and acid etching technique for the OsseoSpeed, Osseotite and SLA surfaces generally showed mainly TiO(2), but a varying surface morphology. In contrast, the electrochemical oxidation process for TiUnite implants not only produces microporous surface (pore size: 0.5-3.0microm), but also changes surface chemistry due to incorporation of anions of the used electrolyte. As a result, TiUnite implants contain more than 7at.% of P in oxide layer and higher amounts of hydroxides compared to the other implants in XPS analysis. F in OsseoSpeed implants was detected at 0.3% before as well as after sputter cleaning.